Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Jingyuan Road 5, Beijing, 100043, China.
Department of Neurosurgery, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Neurosurg Rev. 2019 Sep;42(3):745-751. doi: 10.1007/s10143-018-1031-4. Epub 2018 Sep 17.
Management of ruptured intracranial aneurysm in elderly patients is still a major challenge in the treatment of cerebrovascular disease. This study aimed to evaluate safety and efficacy profiles of ruptured intracranial aneurysms in elderly patients treated with endovascular techniques (EVTs). We conducted a retrospective case review of 53 consecutive elderly patients with ruptured intracranial aneurysms treated by EVT between the year 2011 and 2016. The patients' angiographic outcomes, clinical outcomes, and procedure-related complications were reviewed retrospectively. Univariate and multivariate logistic analysis were applied to determine the risk factors of aneurysm recurrence and clinical prognosis. In 29 (54.7%) patients, the treatment was attempted with coiling alone. The vascular remodeled technique was applied in 24 (45.3%) patients. At a median angiographic follow-up of 9 months, 35 (67.3%) aneurysms showed stable, 9 (17.3%) were improvement, and 8 (15.4%) were recurrent. According to the multivariate analysis, the size of the aneurysm was independently associated with increased risk of aneurysm recurrence (odds ratio, 1.92; 95% confidence interval, 1.181-2.211; p = 0.006). High Hunt-Hess grade at admission was an independent predictor of poor functional outcome in the multivariate analysis (odds ratio, 5.93; 95% confidence interval, 1.878-33.63; p = 0.008). In 8 (15.1%) patients, it resulted in procedure-related complications. EVT of ruptured intracranial aneurysms in elderly patients is safe, effective, and have low recurrent rate. Recurrence after EVT for ruptured aneurysms is common in cases of large-size aneurysms. The overall clinical outcome was worst in patients presented with high Hunt-Hess grade.
老年患者颅内破裂动脉瘤的治疗仍然是脑血管病治疗中的一大挑战。本研究旨在评估血管内治疗（EVT）治疗老年患者颅内破裂动脉瘤的安全性和疗效。我们对 2011 年至 2016 年间采用 EVT 治疗的 53 例连续老年颅内破裂动脉瘤患者进行回顾性病例分析。回顾性分析患者的血管造影结果、临床结果和与操作相关的并发症。采用单因素和多因素逻辑分析确定动脉瘤复发和临床预后的危险因素。29 例（54.7%）患者单独采用线圈治疗，24 例（45.3%）患者采用血管重塑技术。中位血管造影随访 9 个月，35 例（67.3%）动脉瘤稳定，9 例（17.3%）改善，8 例（15.4%）复发。多因素分析显示，动脉瘤大小与动脉瘤复发风险增加独立相关（比值比，1.92；95%置信区间，1.181-2.211；p=0.006）。入院时的高 Hunt-Hess 分级是多因素分析中功能预后不良的独立预测因子（比值比，5.93；95%置信区间，1.878-33.63；p=0.008）。在 8 例（15.1%）患者中，导致了与操作相关的并发症。EVT 治疗老年患者颅内破裂动脉瘤是安全、有效且复发率低。EVT 治疗破裂动脉瘤后，大动脉瘤患者的复发率较高。高 Hunt-Hess 分级的患者总体临床预后最差。
